Heartbeat: Understanding more about COVID-19 – by David Carruthers

June 10, 2020

Since we first heard about this new virus the world has been trying to understand more about it….Who is most affected? How is it transmitted? Can you be immune to it? Why do some people have a mild illness and other cases end in a tragic outcome? What clinical interventions do patients respond to?

At our Trust, we are no exception to this hunger for information to understand COVID-19 so that we might best protect and treat patients who catch the virus.

We began seeing patients in our acute hospitals with potential coronavirus symptoms in February, but on testing, the initial query cases were negative. Our first confirmed case was at City Hospital on 12 March. We now have information on every patient who has been treated by us with a positive test result, every patient who has sadly died with COVID-19 and all those who we have seen and tested, whose test result came back clear.

We are undertaking our own data analysis on acute admissions to the Trust, contributing to national research projects (clinical, therapeutic and genetic) as well as detailed reviews of mortality data.

This information feeds into wider regional and national data analysis but even within our own Trust we can start to see patterns emerging – although it is important not to jump to conclusions. It is very evident that underlying health conditions contribute to the risk of more severe disease.

Age is a definite risk factor with 47 per cent of all COVID+ patients who have died in our hospitals being over 85 years old. Men seem to be affected more than women. Of the patients we have seen with COVID-19, 58 per cent have hypertension and 39 per cent have diabetes. This is higher for the patients who have died. We have also seen a difference over time since the start of the positive cases at our Trust. More of the patients who died were at City Hospital in March but this has changed in April, indicating the dynamic changing nature of the epidemic. When we have looked at ethnicity, there doesn’t appear to be a disproportionate impact on patients from different ethnic backgrounds at Sandwell Hospital, whereas in March, 39 per cent of the deaths of patients with COVID-19 at City Hospital were in black patients, but only 19 per cent in April which is line with the wider Birmingham population. This could indicate a geographical cluster in March in western Birmingham at the start of the outbreak.

We continue to collect and analyse this information as well as review deaths in our care whether covid-related or not. I am really pleased that our Trust is participating in several research studies on this virus as you can see elsewhere in Heartbeat.

The clinical care of patients in hospitals is also being reviewed carefully. The early provision of oxygen therapy, proning of patients (patients are placed on their front and the bed is tilted to relieve pressure on the lungs) and increased use of NIV/CPAP seems to be having a positive impact on some patients. We continue to share learning with other NHS organisations and see what has worked well in other parts of the world, modifying our approach to patient care as we learn more. Many thanks to all of you involved in patient care that makes rapid changes in our approach to management of COVID-19 possible.